? Dosing advice for Sam

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Getting more consistent blues for AMPS and PMPS daily. Hoping the slow trend downward in numbers continue. Would be nice to start getting some greens at NADIR.
 
If there are a couple of cycles you could monitor (get a few mid-cycle tests), you could try a little increase to start bringing in some greens.
 
I have given Sam .5 unit with an AMPS of 147 and .75 unit at 152 before and she stayed in safe numbers. If I start Sam on 1 unit tomorrow and her PMPS would be 147 or lower would you suggest we start a sliding scale and give her .75 unit instead of a full unit or give her the 1 unit and see how she responds?
 
Catdaddy87 said:
I have given Sam .5 unit with an AMPS of 147 and .75 unit at 152 before and she stayed in safe numbers. If I start Sam on 1 unit tomorrow and her PMPS would be 147 or lower would you suggest we start a sliding scale and give her .75 unit instead of a full unit or give her the 1 unit and see how she responds?
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The best person to ask about a sliding scale is @JanetNJ.
 
Catdaddy87 said:
I have given Sam .5 unit with an AMPS of 147 and .75 unit at 152 before and she stayed in safe numbers. If I start Sam on 1 unit tomorrow and her PMPS would be 147 or lower would you suggest we start a sliding scale and give her .75 unit instead of a full unit or give her the 1 unit and see how she responds?
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Try 145 and above 1 unit 130-145 0.75

Provided you can monitor. If you can't go more conservative with 0.5
 
I think she'll be OK with the 1.0U and if it does prove to be too much, you could try a fat 0.75U. Also if the sliding scale doesn't bode well with her. There's always a chance it can result in a kitty having more trampoline time :cat:, ECID though.
 
I have an AMPS of 131 and I'm currently stalling. Yesterday she was 131 and after a 20 minute stall she was 163 so I gave her the full 1 unit. I'm expecting the same today. Should I stick with the 1 unit if she doesn't go up any or give her .75? I can come home at lunch to check on her but that will be the only time she can be monitored today until it's time for her PMPS.
 
Ohhhh...I mean that's good, but she didn't rise at all. Can you stall any more? If not, I'd be tempted to skip. I hate to say that, but she isn't going up at all, and she's right at that 130 spot where I can't recommend a shot.
 
You could also try 0.25 if you want and leave some food out for her...what time in the cycle could you come home for lunch?
 
I gave her 1 unit and left some extra food for her. I will go home at lunch and check her which would be +6.5 or +7. That seems to be when she drops. It's a bit aggressive but I haven't had her hit a green number for NADIR yet and she only seems to drop 40-50 points. The more I look at her SS I should of maybe gone with .75.

I think she will be ok there. I'm always nervous and second guess when I have to change her dose but she hasn't given me a scare on the Prozinc yet. ;)
 
Catdaddy87 said:
I gave her 1 unit and left some extra food for her. I will go home at lunch and check her which would be +6.5 or +7. That seems to be when she drops. It's a bit aggressive but I haven't had her hit a green number for NADIR yet and she only seems to drop 40-50 points. The more I look at her SS I should of maybe gone with .75.

I think she will be ok there. I'm always nervous and second guess when I have to change her dose but she hasn't given me a scare on the Prozinc yet. ;)
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Definitely get some mid cycle tests today - they're essential in knowing what the dose is doing. I know you badly want to see green but this is a process that can't be rushed.
 
I would really recommend that you get a curve as soon as you have a day when you can. You don't actually have enough data to know for sure how she drops right now. The last curve you had was on a 0.25 dose which was too low. She could be hitting lower numbers at a time when you aren't testing.

Also, looking at your note, her first test was 118. A non-diabetic cat is between 50-120, which means they don't need insulin in those ranges.

Based on the data you do have, and since you left food out for her, I think she'll be alright (though please do go home at lunch to check on her!), but if this happens again, I would recommend giving a reduced dose or skipping unless you'll be around to monitor more. Sam's numbers aren't so bad that you need to be overly aggressive in your dosing right now. She's below the renal threshold most of the time, and her numbers are coming down, which usually calls for a more conservative approach.
 
Kris & Teasel said:
Definitely get some mid cycle tests today - they're essential in knowing what the dose is doing. I know you badly want to see green but this is a process that can't be rushed.
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I will go home at lunch to get a test. I work half a day tomorrow so I can get mid cycle tests then and this weekend.

I was worried that what I said may have come off as I was really pushing for greens but I meant that she hasn't hit any yet so that is why I figured she would be ok with 1 unit. I'm not trying to rush it, I'm in it for the long haul.
 
Djamila said:
I would really recommend that you get a curve as soon as you have a day when you can. You don't actually have enough data to know for sure how she drops right now. The last curve you had was on a 0.25 dose which was too low. She could be hitting lower numbers at a time when you aren't testing.

Also, looking at your note, her first test was 118. A non-diabetic cat is between 50-120, which means they don't need insulin in those ranges.

Based on the data you do have, and since you left food out for her, I think she'll be alright (though please do go home at lunch to check on her!), but if this happens again, I would recommend giving a reduced dose or skipping unless you'll be around to monitor more. Sam's numbers aren't so bad that you need to be overly aggressive in your dosing right now. She's below the renal threshold most of the time, and her numbers are coming down, which usually calls for a more conservative approach.
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The first test and second test were within 1 minute of each other because I wanted to make sure it wasn't a bad strip.

I appreciate all of the advice. I may not have many full curves but I have tested at +3 and +4 a decent amount and she doesn't seem to drop until after at +6 or +7. Not trying to argue, but just have an open conversation about why I chose the dosage and why you make your recommendation for the sake of learning more on my part. I just want to take the best care of her possible by learning as much as possible. Please don't take my comments as being argumentative. I know is hard to interpret meanings and attitudes via text sometimes. I like to know how and why as much as possible so I can be as self reliant as possible.

She seemed to not drop much or at all on the .75 sometimes so I decided to try 1 and see what happens at a low number. Almost waited till tomorrow to try 1 unit if she had a low preshot. I will update everyone at lunch. Thanks so much for all of the help to this point. If she has a PMPS of 130 or so and does ok today, would you recommend .75? I'm asking in advance because a lot of times I can't get an recommendation in time for her shot.
 
Hmmm...maybe I'm confused. I don't see +3 and +4 data, but you said you tested at those times a decent amount, and that the drops happened later. I'm also not seeing cycles that show the +3 and +6 in the same cycle to see the drop at this dose. Which cycles should I be looking at?

Most cats don't hit nadir until +5 to +7, so likely her nadir isn't until sometime in that range, but again ECID. Mama-sense and papa-sense are real things, so you are most likely exactly right, but since we are out here on the internet, we have to rely on the data we can see to draw conclusions.

Sam hasn't shown dramatic drops (at least not that we can see), but her numbers are wiggling down, which when you consider the overall pattern is an indication that caution in dosing is appropriate. Cats on their way down can surprise you in a way that cats on their way up don't. And when the insulin grabs hold of an already low number, it will sometimes just cause the kitty to surf in a good range, but sometimes it will cause a dive. Since we can't be there to help ensure a kitty's safety, we error on the side of caution. As I said before, based on the data I can see, I'm guessing she's fine today, even if the full dose isn't what most of us would advise for an un-monitored cycle. We often use the phrase, "you hold the syringe" around here. You are always welcome to make whatever decision you think is best, regardless of anything anyone here suggests.
 
Djamila said:
Hmmm...maybe I'm confused. I don't see +3 and +4 data, but you said you tested at those times a decent amount, and that the drops happened later. I'm also not seeing cycles that show the +3 and +6 in the same cycle to see the drop at this dose. Which cycles should I be looking at?

Most cats don't hit nadir until +5 to +7, so likely her nadir isn't until sometime in that range, but again ECID. Mama-sense and papa-sense are real things, so you are most likely exactly right, but since we are out here on the internet, we have to rely on the data we can see to draw conclusions.

Sam hasn't shown dramatic drops (at least not that we can see), but her numbers are wiggling down, which when you consider the overall pattern is an indication that caution in dosing is appropriate. Cats on their way down can surprise you in a way that cats on their way up don't. And when the insulin grabs hold of an already low number, it will sometimes just cause the kitty to surf in a good range, but sometimes it will cause a dive. Since we can't be there to help ensure a kitty's safety, we error on the side of caution. As I said before, based on the data I can see, I'm guessing she's fine today, even if the full dose isn't what most of us would advise for an un-monitored cycle. We often use the phrase, "you hold the syringe" around here. You are always welcome to make whatever decision you think is best, regardless of anything anyone here suggests.
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Thanks for the extra info. I will update the thread when I go home in an hour.
 
Sam was at 183 for +7. I'm sure she got a glucose dump because of the lower than normal numbers. Curious to see what her PMPS will be. I will post here again then.
 
Cool! She'll probably be fine since she doesn't drop much, but any data you can get to be sure she's staying safe, and to see what the dose does, is good!
 
Sam is at 144 this AMPS. Should I give 1 unit to try and keep the consistency and let her adjust or go with .75 to see if she will stay about level or small drop since she is almost at a normal range?
 
Catdaddy87 said:
I went with .75 and will try to get a curve today and see where she goes with her BG.
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Good call I think. It's surprising that she didn't have a much different PMPS yesterday after the NS in the morning. She appears to stay very flat and the curve today will be interesting to see.
 
210 at +3 :facepalm: I figured it will be higher than the AMPS because she has eaten and the insulin hasn't started yet but that is a good jump for LC FF.
 
That's not really too bad. I think that's within the variance (though I'm not a math person, so don't quote me on that!). I'm sure it will come down in a bit. :)
 
looks like she only went up from her AMPS until now. She will be getting tested in the next 30 minutes. If she is still around 200 I will give 1 unit for sure. If her AMPS tomorrow is 140 or less would you say go with 1 unit or do you think she had a bounce from the 140 and it wasn't necessarily too low of a dose?
 
Catdaddy87 said:
looks like she only went up from her AMPS until now. She will be getting tested in the next 30 minutes. If she is still around 200 I will give 1 unit for sure. If her AMPS tomorrow is 140 or less would you say go with 1 unit or do you think she had a bounce from the 140 and it wasn't necessarily too low of a dose?
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Dosing based on bounce numbers isn't a good idea. Sam doesn't seem to be particularly bouncy, though. You have to judge a dose on both PS and nadir values. I tend to focus a bit more on nadir because too low is riskier than too high. She might have been OK with a 1 u on this AM's PS but it's hard to know for sure. I'm basing that on the flatness of her responses to date.
 
I will give 1 unit tonight and see what she gives for AMPS tomorrow. Do you suggest .75 again tomorrow if she is 145 or less to see if she was bouncing today?
 
Catdaddy87 said:
I will give 1 unit tonight and see what she gives for AMPS tomorrow. Do you suggest .75 again tomorrow if she is 145 or less to see if she was bouncing today?
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Hard to decide because she doesn't have a very distinct nadir. If she was mine and I was able to monitor carefully, I'd be tempted to try 1 u on a PS similar to this AM's.
 
Kris & Teasel said:
Hard to decide because she doesn't have a very distinct nadir. If she was mine and I was able to monitor carefully, I'd be tempted to try 1 u on a PS similar to this AM's.
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That's what I'm thinking. She hasn't seemed to drop very far on any dose so far. Once or twice a while back. I think that was on Vetsulin also and she wasn't eating normal amounts of food yet.

I do have some things I have to leave and take care of tomorrow but I should be home to check on her throughout the day. I will probably give 1 unit and monitor her. I feel pretty confident in steering her if she drops too low.
 
Most of those are within the 20% meter variance, so essentially a flat curve. You can increase to 1.25 u soon on a day when you can monitor.
 
Kris & Teasel said:
Most of those are within the 20% meter variance, so essentially a flat curve. You can increase to 1.25 u soon on a day when you can monitor.
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Thanks. I will have to wait until Friday or Saturday to up the dose. I'm curious to see if her pre shot numbers start coming down again until then.
 
Sam has been bumped up to 1.5 and she is dropping a little earlier after the shot but still not dropping much and staying kind of flat. Hoping she will start dropping throughout the week. If not, I will go to 1.75 this weekend when I can monitor. Let me know if anyone is seeing anything different on her SS.
 
I think it's time to increase her dose. It's her pattern to stay quite flat but the whole curve can come down some.
 
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